The Art of Communication

in NursingCathy GroggelNursing 450

★ To understand the basic components and forms of communication.

★ To understand the importance of effective communication in the healthcare environment.

★ Discuss what approaches and techniques are useful for nurses in communicating with their patients and families.

★ Understand the barriers in communication and how improvements can be made in nursing.

Objectives:

The Who?What?

Where?

When?

Why?How?

Communication

Communication

“Effective communication is the creation of meaning in communication in which patients and healthcare providers exchange information so that patients are able to actively participate in their care.”Boykins, 2014, p. 40

Measurement Materials Method Patient Satisfaction Written Verbal

NDNQI Content Non-Verbal Training/Skills Medical Jargon Manner Time Brochures Emotions Safety Reports Cue-Cards Feelings

Errors Interpreters Task ApproachMedication Respect/Dignity

Noise Nurse EMR Lighting Physician Email Home Unlicensed Personnel Telephone Hospital Patient Texting Privacy Family Members Social MediaReadiness Age Web

Distractions Socio-economic Status Environment Manpower Machine

Root Cause Analysis

Communication Breakdowns

“Between 1995 and 2005, ineffective communication and breakdowns in working together was the root cause of 66% of healthcare errors (Hughes, 2008).”

Sherwood & Zomorodi, 2014, p. 17

“…suggest that an estimated ‘70-80% of healthcare errors are caused by human factors associated with poor team communication and understanding.’”

Bleakley& Marshall, 2013, p. 128

“The nurse should be able to build communication and leadership skills in practice settings, to function effectively within nursing and other interprofessional teams, to foster open communication, to demonstrate mutual respect, and to engage in shared decision making to achieve quality care.”

Boykins, 2014, p. 42

★ It’s the Right thing to do!★ The Joint Commission includes Patient-

Centered communication as a Standard for Hospitals.

★ ANA Standards of Professional Nursing Practice.

★ Quality and Safety Education for Nursing (QSEN).

★ AACN

SMR

AssessmentImplementationCollaborationEnvironmental Health

Communication

“The nurse caring for the acutely and critically ill patient uses skilled communication to

collaborate withthe team of patient, family, and healthcare

providers in providing patient care in a safe, healing, humane,

and caring environment.”

AACN, p.16

Basic Components of Communication

“Human communication is a two-person process in which both individuals influence and are influenced by each other.”

Kearney-Nunnery, 2008, p. 124

★Source/Encoder★Message★Channel★Receiver

SMRC Model by David Berlo in 1960

Source-Message-Channel-Receiver Model

Kearney-Nunnery, 2008, p. 125

Health Communications

ModelTypes of Relationships

Kearney-Nunnery, 2008, p. 125

Professional/ProfessionalProfessional/ClientProfessional/Significant otherClient/Significant other

Transaction TypesVerbalNon-verbal

Contexts

Setting One on one

GroupKearney-Nunnery, 2008, p. 127

Health Communications Model

Forms of Communication

★Metacommunication

★ Verbal■ Vocabulary■ Meaning■ Intonation■ Pacing■ Clarity/Timing

“Nurses should also demonstrate credibility, which is defined as a sense of trustworthiness, sincerity, reliability, and integrity. The nurse must be dependable and believable.”

Kearney-Nunnery, 2008, p.129

★Non-Verbal Communication■ Body Language■ Cultural differences

● Personal space● Gestures● Eye contact● Touch

■ Use of space■ Appearance

Kearney-Nunnery, 2008, p. 130-132

★ Involvement of Patient■ Patient-centeredness

★ Sensitivity in Providing Information and Explanations

■ Quality■ Readiness

★ Task Approach★ Manner of Approach

■ Rapport■ Tone■ Pleasant

Approaches in Communication

“The words people say are important, but the way they are said is important too. When we talk to someone, we choose the words to use and modify the way they are used on the basis of an unconscious appraisal of that person.”Draper, 2014, p. 276

★ Tools■ Question types

★ Active listening■ Interest■ Attention■ Restatement/Reflection

★ Questioning■ Open-ended■ Close-ended■ Circular■ Goal oriented

★ Understanding■ Elaboration■ Alternatives

★ Non-Verbal★ Silence

Communication Techniques

Communication Barriers★ Distractions

■ Nurse■ Sensory

★ Knowledge Level ■ Deficits

★ Interpretation■ Language■ Cultural

■ Literacy level

Communication Barriers★ Training

■ Inadequate Nurse Training■ Poor planning

★ Emotions■ Regulate

★ Time

Yoder-Wise, 2014, p. 350-351

Communication Pitfalls

“...pitfalls in communication comprise actions, behaviors, and words that create distrust, are dishonoring, and decrease the feelings of self-worth in the receiver and can lead to poor outcomes for patients.”Yoder-Wise, 2014, p. 351

Improving Communication★ Speak-Up

■ https://www.youtube.com/watch?v=rOlCMLbOm6c

★ Share stories■ Near-misses■ Simulated learning

★Change Behavior■ Classes■ Scripting■ Emotions■ Be accountable

Improving Communication

★Use Standard Methods of Communication■ Bedside Handovers■ SBAR■ Read-Backs■ Briefings/Huddles■ Huddles■ Interdisciplinary Rounds■ Nurse Liaison

★Research in Nursing

Improving Communication

Types of Communication

★ Face to face

Types of Communication

Written

Types of Communication

Email

Types of Communication

Electronic Health/Medical Records

Types of Communication

Telephone

Types of Communication

Text Messaging

Types of Communication

Social Media

Future CommunicationsNursing Impact

★ Improving patient outcomes★ Enhancing patient connection★ Improving efficiencies★ Decreasing costs★ Strengthen communication★ Informed decision making★ Standardizing report★ Engaging patients

American Association of Critical-Care Nurses. (n.d.). Standards. In American Association of Critical-Care Nurses. Retrieved June 22, 2014, from

http://www.aacn.org/WD/Practice/Content/standards.content?menu=Practicetww.aacn.org/WD/Practice/Contenstadards.content?menu=PracticeAmerican Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.)

Silver Spring, MD: Nursebooks.org.

Bleakley, A., & Marshall, R. (2013). Can the science of communication inform the art of the medical humanities?. Medical Education, 47(2), 126-133. doi:10.1111/medu.12056

Boykins, D. (2014). Core Communication Competencies in Patient-Centered Care. ABNF Journal, 25(2), 40-45.

Davies, N. (2014). Empathic nursing: going the extra mile. Practice Nursing, 25(4), 198-202.

Draper, P. (2014). Words, words, words: conversation as a tool to promote wellbeing. Nursing & Residential Care, 16(5), 275-277.

Kearney-Nunnery, R. (2008). Advancing your career: Concepts of professional nursing (4th ed.). Philadelphia, PA: F. A. Davis Company.

References

Leef, B. L., & Hallas, D. (2013). The Sensitivity Training Clown Workshop: Enhancing Therapeutic Communication Skills in Nursing Students. Nursing Education Perspectives, 34(4), 260-264.

McGilton, K., Boscart, V., Fox, M., Sidani, S., Rochon, E., & Sorin-Peters, R. (2009). A systematic review of the effectiveness of communication interventions for health care providers caring for patients in

residential care settings. Worldviews On Evidence-Based Nursing, 6(3), 149-159. doi:10.1111/j.1741-6787.2009.00155.x

O'Hagan, S., Manias, E., Elder, C., Pill, J., Woodward-Kron, R., McNamara, T., & Webb, G., & McColl, G. (2013, October). What counts as effective communication in nursing? Evidence from a nurse educators' view and clinicians' feedback on nurse interactions with simulated patients. Journal of Advanced Nursing, 70(6), 1344-1356.

Sherwood, G., & Zomorodi, M. (2014). A New Mindset for Quality and Safety: The QSEN Competencies Redefine

Nurses' Roles in Practice. Nephrology Nursing Journal, 41(1), 15-72.

Spruce, L. (2014). Back to Basics: Speak Up. AORN Journal, 99(3), 407-415. doi:10.1016/j.aorn.2013.10.020

Tremayne, P. (2014). Using humour to enhance the nurse-patient relationship. Nursing Standard, 28(30), 37-40.

Yoder-Wise, P. S. (2014). Leading and managing in nursing: Revised reprint (5th ed.). St. Louis, MO: Elsevier Inc.

References